Early Transcatheter Arterial Embolization for the American Association for the Surgery of Trauma Grade 4 Blunt Renal Trauma in Two Institutions

Yanagi, Masato; Suzuki, Yasutomo; Hamasaki, Tsutomu; Mizunuma, Kimiyoshi; Arai, M.; Murata, Satoru; Kondo, Yukihiro; Nishimura, Takuya

doi:10.1272/jnms.jnms.2018_85-31

Cited by 8 publications

(9 citation statements)

References 10 publications

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“…This finding is consistent with previous reports [15]. The vascular subgroup of Grade IV trauma, including segmental renal artery or vein injury, containing hematoma, partial vessel laceration, and vessel thrombosis, can be successfully treated by interventional therapy [19]. Embolization, angioplasty, and surgical exploration can be considered for patients who fail conservative treatment [20].…”

Section: E922802-6supporting

confidence: 90%

A Comparative Study of Conservation, Endovascular Embolization Therapy, and Surgery for Blunt Renal Trauma

Xiao

et al. 2020

Med Sci Monit

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This study was funded in part by the Sichuan Provincial Department of Education (No. 17ZB0169) Background: In this study, we evaluated the advantages and disadvantages of angioembolization in patients with Grade III-V blunt renal trauma compared with other treatments. Material/Methods: We prospectively collected data on patients hospitalized for Grade III-V blunt renal trauma. Organ damage was graded according to the American Association for the Surgery of Trauma (AAST) criteria. Initial grouping was then performed according to the hemodynamics and "initial treatment". The eligible patients were divided into 3 groups: conservative treatment group (Group A), arterial embolization group (Group B), and surgical group (Group C). The success rate, significance, and follow-up renal function were evaluated. Results: In Group B of Grade IV, estimated glomerular filtration rate (eGFR) and serum creatinine (Scr) levels were slightly decreased and increased, respectively, after embolization compared with before embolization (P=0.002, P=0.039). In Grade V, the eGFR of Group B after embolization was lower than before embolization (P=0.041); The levels of serum urea (Urea) and Scr in Group B after treatment were higher than those before treatment (P=0.042, P=0.024). Conservative treatment and angioembolization were better than exploration in protecting renal function of Grade IV (P=0.035 and P=0.047, respectively). Conclusions: The success rate of angioembolization was high and protected renal function to the greatest extent, and there were no differences in renal function at long-term follow-up. However, it is difficult to manage renal vessel laceration or avulsion by embolization alone, and various endovascular therapies are required to protect the function of residual kidneys.

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Section: E922802-6supporting

confidence: 90%

A Comparative Study of Conservation, Endovascular Embolization Therapy, and Surgery for Blunt Renal Trauma

Xiao

et al. 2020

Med Sci Monit

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“…CT criteria, such as absence of major visceral injuries, perirenal hematoma rim distance, discontinuity of Gerota’s fascia, or intravascular contrast extravasation were used to select patients for RAE [ 12 , 19 , 20 ]. Failure of conservative management due to unresponsive to fluid resuscitation hypotension or persistent gross haematuria represent further indication [ 16 , 21 – 23 ].…”

Section: Resultsmentioning

confidence: 99%

The role of angioembolization in the management of blunt renal injuries: a systematic review

et al. 2021

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Background Recently, renal angioembolization (RAE) has gained an important role in the non-operative management (NOM) of moderate to high-grade blunt renal injuries (BRI), but its use remains heterogeneous. The aim of this review is to examine the current literature on indications and outcomes of angioembolization in BRI. Methods We conducted a search of MEDLINE, EMBASE, SCOPUS and Web of Science Databases up to February 2021 in accordance with PRISMA guidelines for studies on BRI treated with RAE. The methodological quality of eligible studies and their risk of bias was assessed using the Newcastle–Ottawa scale Results A total of 16 articles that investigated angioembolization of blunt renal injury were included in the study. Overall, 412 patients were included: 8 presented with grade II renal trauma (2%), 97 with grade III renal trauma (23%); 225 with grade IV (55%); and 82 with grade V (20%). RAE was successful in 92% of grade III–IV (294/322) and 76% of grade V (63/82). Regarding haemodynamic status, success rate was achieved in 90% (312/346) of stable patients, but only in 63% (42/66) of unstable patients. The most common indication for RAE was active contrast extravasation in hemodynamic stable patients with grade III or IV BRI. Conclusions This is the first review assessing outcomes and indication of angioembolization in blunt renal injuries. The results suggest that outcomes are excellent in hemodynamic stable, moderate to high-grade renal trauma.

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“…One study showed a low initial rate of embolization success (63%), but when repeat embolization was performed the clinical success rate increased to 95% (33). That study reported markedly different results when compared to others which showed between 94.4-100% initial clinical success rates of non-operative management for stable patients with AAST grade IV and V renal injuries when triaged to embolization (32,(34)(35)(36)(37)(38). Pediatric patients with blunt abdominal trauma and evidence of vascular injury on CT have a very high success rate when treated with angiography and embolization (reported up to 100%) and a low morbidity rate (39)(40)(41).…”

Section: Discussionmentioning

confidence: 93%

Endovascular embolization in renal trauma: a narrative review

Smith¹,

Eastaway²,

Hartt³

et al. 2021

Ann Transl Med

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Approximately 1-3% of all trauma patients have a renal injury. Eighty percent of renal trauma is due to blunt injury, with the remainder due to penetrating trauma which is most often iatrogenic. Contrast enhanced computed tomography is used to triage patients and offers a quick and accurate assessment of any potential organ injury. If injury is present, The American Association for the Surgery of Trauma grading system can both grade renal injuries and be used to help guide management and intervention. Grades are assigned based on imaging and clinical features of renal trauma, and have prognostic and treatment implications for patients. The objective of this narrative review is to identify optimal management of patients with renal trauma, specifically which patients can be treated with endovascular interventions following renal trauma, which can be observed, and which would be best managed surgically. For hemodynamically stable patients with renal trauma, endovascular angiography and embolization is a non-invasive approach that can be used to control bleeding and potentially avoid surgery or nephrectomy in select cases. Future research is needed to determine if a specific antibiotic regimen is needed prior to or following embolization. Further research is needed to evaluate the effectiveness of endovascular management of high-grade renal trauma (grade V). Complications of renal embolization include short-term hypertension, long term hypertension in cases of significant ischemia, acute kidney injury, and infection.

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Early Transcatheter Arterial Embolization for the American Association for the Surgery of Trauma Grade 4 Blunt Renal Trauma in Two Institutions

Cited by 8 publications

References 10 publications

A Comparative Study of Conservation, Endovascular Embolization Therapy, and Surgery for Blunt Renal Trauma

A Comparative Study of Conservation, Endovascular Embolization Therapy, and Surgery for Blunt Renal Trauma

The role of angioembolization in the management of blunt renal injuries: a systematic review

Endovascular embolization in renal trauma: a narrative review

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